Bensham Family Practice

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Fill out a simple online form to get advice and treatment by the end of the next working day.

Subject Access Request (SAR)

You will appreciate that health data relating to any individual is highly confidential and the Practice must ensure that it releases such data only to the person to whom it relates, or to a person authorised to act on his or her behalf. If you require to see any health data, please complete this online Request Form as fully and accurately as possible to enable us to locate the exact information you require.

The General Data Protection Regulations (GDPR) gives you the statutory right of access to any information, manual (paper) or computerised.  You may wish to authorise someone else to make your application on your behalf and if you have parental responsibilities you may make an application to see your child’s notes, if they are under the age of twelve years.

You do not have to give a reason for applying for access to your General Practice records. If you do not need access to your entire records, it would be helpful if you would inform us of the periods and area of your health records that you require, along with details which you feel may have relevance (e.g. clinic type, location, dates).

Timescale

The Practice will deal with your request as quickly as possible. If you request copies of all or part of your medical record, these will be ready within the allocated timescales specified by the Regulations (which is currently 28 days from receipt of your accurately completed form and confirmation of consent), and we will telephone you when they are available for you to come to the Practice to collect them. Under certain circumstances, this period can be extended to 3 months but we will keep you informed of the progress of your request during this extended period.

Fees

We will not make a charge for the first request for access to your medical records. We may, however, charge for subsequent requests or if we deem that the volume of information requested is excessive. You have the right to simply view your records (i.e. not receive a copy in a permanent form); information on how to arrange this is detailed below.

Type of request

If you request to see the original records, you will be invited to make an appointment at a mutually convenient time to view them.  If you request copies, these will be ready within the allocated timescales specified by the Regulations, and we will telephone you when they are available for you to come to the Practice to collect them. 

Proof of identity

Two forms of identity must be provided (one of which must be photographic). This is to ensure information is not released to unauthorised individuals. The table below outlines the proof of identity we can accept.

TYPE OF APPLICATIONIDENTIFICATION REQUIRED
Patient applying for their own 
Can be waived if the applicant is known to the Staff Member accepting the request
One which must be 
photographic i.e. 
passport. One containing individuals 
name and address
Third Party Applying. Consent of Patient will be 
required  BEFORE the request will be 
processed
One containing Third Party name and 
address One must be Photographic ID 
of Third Party  
Applying on behalf of a child 

We will ALWAYS obtain consent for release of 
records from a child age 12+ to <16 if a third party is making request
One which must be Child’s 
birth certificate Photographic ID of person with parental rights

If you are completing this application on behalf of another person, the Practice will require their authorisation before we can release the data to you. The person whose information is being requested should sign the relevant section within the online form. If the patient is a child (i.e. under 16 years of age) the application may be made by someone with parental responsibilities – in most cases this means a parent or guardian. If the child is capable of understanding the nature of the application, his or her consent should be obtained or, alternatively, the child may submit an application on their own behalf.  Children will, generally, be presumed to understand the nature of the application if aged between 13 and 16 however, all cases will be considered individually.

Subject Access Request Form

Applicant Details

I am requesting
Please note if you are not the patient, and you have the permission of a third party to act on their behalf, then both persons must be present when completing this online form.

We will require them to complete “The Authorisation of Patient if Request made by Third Party” declaration shown below. This section will appear when the relevant consent box is ticked at the end of the online form.

If this section is not completed, we cannot process the subject access request.

Enter Email
Confirm Email
Please use format day/month/year e.g. 12/05/1979

The Medical Records of another Adult

Please include postcode
Please use format day/month/year e.g. 12/05/1979

The Medical Records of a Child

Please include postcode
Please use format day/month/year e.g. 12/05/1979

Type of Request

I wish to request

Copy of Parts of Medical Records

Please detail which parts you require

Medical Records

Other

Consent

Tick which applies

AUTHORISATION OF PATIENT IF REQUEST MADE BY A THIRD PARTY

I authorise the Practice to release Personal Data requested relating to me to the above applicant to whom I have given my consent to act on my behalf.

Privacy Policy

This form collects your name, date of birth, email, other personal information and medical details. This is to confirm you are registered with the practice, to allow the practice team to contact you and also to update your medical records held by the practice and our partners in the NHS. Please read our Privacy Policy to discover how we protect and manage your submitted data.